» Articles » PMID: 31959611

Postnatal Care Following Hypertensive Disorders of Pregnancy: a Qualitative Study of Views and Experiences of Primary and Secondary Care Clinicians

Overview
Journal BMJ Open
Specialty General Medicine
Date 2020 Jan 22
PMID 31959611
Citations 7
Authors
Affiliations
Soon will be listed here.
Abstract

Objectives: To explore clinicians' views and experiences of caring for postnatal women who had hypertensive disorders of pregnancy (HDP), awareness of relevant National Institute for Health and Care Excellence (NICE) guidance to inform their postnatal management, the extent to which NICE guidance was implemented, barriers and facilitators to implementation and how care could be enhanced to support women's future health.

Design: A qualitative study using semistructured interviews. Thematic analysis was used for coding and theme generation.

Setting: Four National Health Service maternity units and three general practice clinics in South-East and South-West London.

Participants: A maximum variation, purposive sample of 20 clinicians with experience of providing postnatal care to women following HDP.

Results: Four main themes were generated: variation in knowledge and clinical practice; communication and education; provision of care; locus of responsibility for care. Perceived barriers to implementation of NICE guidance included lack of postnatal care plans and pathways, poor continuity of care, poor antihypertensive medication management, uncertainty around responsibility for postnatal care and women's lack of awareness of the importance of postnatal follow-up for their future health. Some clinicians considered that women were discharged from inpatient care too soon, as primary care clinicians did not have specialist knowledge of HDP management. Most clinicians acknowledged the need for better planning, communication and coordination of care across health settings.

Conclusions: Evidence of longer term consequences for women's health following HDP is accumulating, with potential for NICE guidance to support better outcomes for women if implemented. Clinicians responsible for postnatal care following HDP should ensure that they are familiar with relevant NICE guidance, able to implement recommendations and involve women in decisions about ongoing care and why this is important. The continued low priority and resources allocated to postnatal services will continue to promote missed opportunities to improve outcomes for women, their infants and families.

Citing Articles

Early Mortality, Cardiovascular, and Renal Diseases in Women's Lives Following Hypertensive Disorders of Pregnancy: The Prospective Nationwide Study CONCEPTION.

Lailler G, Grave C, Gabet A, Joly P, Regnault N, Deneux-Tharaux C J Am Heart Assoc. 2024; 13(8):e033252.

PMID: 38563390 PMC: 11262502. DOI: 10.1161/JAHA.123.033252.


Preventive Primary Care in the Postpartum Year: The Role of Medicaid Delivery System Reform.

Geissler K, Jeung C, Attanasio L Am J Prev Med. 2024; 67(2):184-192.

PMID: 38484901 PMC: 11260532. DOI: 10.1016/j.amepre.2024.03.005.


Qualitative systematic review of general practitioners' (GPs') views and experiences of providing postnatal care.

Macdonald C, MacGregor B, Hillman S, MacArthur C, Bick D, Taylor B BMJ Open. 2023; 13(4):e070005.

PMID: 37045584 PMC: 10106050. DOI: 10.1136/bmjopen-2022-070005.


Self-management system for postpartum women with hypertension disorders: an eHealth application intervention study.

Chang C, Tsai Y, Hsu Y, Hou T BMC Pregnancy Childbirth. 2023; 23(1):184.

PMID: 36927463 PMC: 10018986. DOI: 10.1186/s12884-023-05483-y.


Optimising mothers' health behaviour after hypertensive disorders of pregnancy: a qualitative study of a postnatal intervention.

Rossiter C, Henry A, Roberts L, Brown M, Gow M, Arnott C BMC Public Health. 2022; 22(1):1259.

PMID: 35761317 PMC: 9235190. DOI: 10.1186/s12889-022-13590-2.


References
1.
Brouwers L, van der Meiden-van Roest A, Savelkoul C, Vogelvang T, Lely A, Franx A . Recurrence of pre-eclampsia and the risk of future hypertension and cardiovascular disease: a systematic review and meta-analysis. BJOG. 2018; 125(13):1642-1654. PMC: 6283049. DOI: 10.1111/1471-0528.15394. View

2.
Say L, Chou D, Gemmill A, Tuncalp O, Moller A, Daniels J . Global causes of maternal death: a WHO systematic analysis. Lancet Glob Health. 2014; 2(6):e323-33. DOI: 10.1016/S2214-109X(14)70227-X. View

3.
Kayem G, Kurinczuk J, Spark P, Brocklehurst P, Knight M . Maternal and obstetric factors associated with delayed postpartum eclampsia: a national study population. Acta Obstet Gynecol Scand. 2011; 90(9):1017-23. DOI: 10.1111/j.1600-0412.2011.01218.x. View

4.
Theilen L, Meeks H, Fraser A, Esplin M, Smith K, Varner M . Long-term mortality risk and life expectancy following recurrent hypertensive disease of pregnancy. Am J Obstet Gynecol. 2018; 219(1):107.e1-107.e6. PMC: 6019643. DOI: 10.1016/j.ajog.2018.04.002. View

5.
Coyne I . Sampling in qualitative research. Purposeful and theoretical sampling; merging or clear boundaries?. J Adv Nurs. 1997; 26(3):623-30. DOI: 10.1046/j.1365-2648.1997.t01-25-00999.x. View